Abstract
BackgroundThe prognostic value of heart failure specific and global health status before and after left ventricular assist device (LVAD) implantation in the usual care setting is not well studied.MethodsWe included 3,836 continuous-flow LVAD patients in the INTERMACS registry. Health status was measured pre-operatively and 3 months post-LVAD using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and EuroQol visual analog scale (VAS). Primary outcomes were mortality/rehospitalization. Inverse propensity weighting was used to minimize bias from missing data.ResultsPre-operative global and heart failure-specific health status were very poor: KCCQ median 34.6 (IQR 21.4-50.5); VAS median 43 (interquartile range (IQR) 25–65). Health status measures improved 3 months after LVAD placement: KCCQ median 69.3 (IQR 54.2-82.3); VAS median 75 (IQR 60–85). Pre-operative health status was not associated with death (unadjusted HR for lowest vs. highest score quartiles: 1.09 (0.85-1.41) KCCQ; 1.12 (0.85-1.49) VAS) or rehospitalization (unadjusted HR 0.83 (0.72-0.96) KCCQ; 0.99 (0.85-1.16) VAS). Three-month KCCQ was associated with mortality (unadjusted HR 2.17 (1.47-3.21); VAS was not (1.43 (0.94-2.17). Three-month KCCQ added incremental discriminatory value to the HeartMate II Risk Score for death (c-stat 0.60 to 0.66); VAS did not (c-stat 0.59 to 0.60). Three-month health status was associated with rehospitalization (unadjusted HR 1.31 (1.15-1.57) KCCQ; 1.24 (1.05-1.46) VAS), but did not add incremental discriminatory value (c-stat 0.52 to 0.55 and 0.54, respectively).ConclusionsThese real-world data suggest that pre-operative health status has limited association with outcomes after LVAD. However, persistently low health status after surgery may independently signal higher risk for subsequent death. Further study is needed to determine the clinical utility of routinely collected health status data after LVAD implantation.
Highlights
The prognostic value of heart failure specific and global health status before and after left ventricular assist device (LVAD) implantation in the usual care setting is not well studied
Background survival and adverse events following left ventricular assist device (LVAD) placement have improved over time, 2-year survival after LVAD remains at 70% in the modern era [1]
While preprocedure health status may not be prognostic of longterm outcomes after LVAD implantation due to a major “resetting” of patients’ health status with treatment, postprocedure health status may be associated with long-term outcomes, and assist in the planning for further treatment
Summary
The prognostic value of heart failure specific and global health status before and after left ventricular assist device (LVAD) implantation in the usual care setting is not well studied. Poor health status is an important outcome to patients, but is a strong independent predictor of subsequent hospitalization and mortality in patients with heart failure [7,8,9,10] and those undergoing cardiac surgery [11,12,13,14] These findings do not necessarily extend to patients undergoing LVAD implantation, as pre-operative heart failure-specific health status was not associated with mortality after LVAD in the clinical trial setting [15]. Confirming these hypotheses in a contemporary, realworld setting may identify health status as a means for quantifying the benefits and risks of this treatment, and as a tool to help guide clinical decisionmaking in the LVAD population
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
